Neuropsychological and gray matter volume changes in patients with multiple sclerosis after a computer-assistí cognitive rehabilitation therapy with NeuronUP

In this article we discuss the study carrií out to evaluate the effectiveness of applying a computer-assistí cognitive rehabilitation therapy, NeuronUP, in patients with multiple sclerosis (MS).

Authors

Julio Plata-Bello, *María Yaiza Pérez-Martín, Montserrat González-Platas, Víctor Fajardo-Santana, KritsiaSinayFumero-Revetti Neurosurgery Service, University Hospital of the Canary Islands, San Cristóbal de La Laguna, Spain *Corresponding author [email protected]

Declaration

The authors declare no conflicts of interest.

Reference

EMJ Neurol. 2018;6[1]:46-48. Abstract Review No. AR1.

Background

More than 65% of patients with multiple sclerosis (MS) usually present cognitive impairment both in the early stages and in the advancí phases of the disease; this impairment progresses over time. Multiple sclerosis can have considerable effects on patients’ quality of life, work, daily functioning and independence.

Cognitive treatment yields contradictory results, probably because the interventions and outcome measures are heterogeneous. Nevertheless, several studies have shown that neuropsychological intervention can have úvorable effects on patients’ cognitive performance. Specifically, there is evidence that computer-assistí cognitive rehabilitation improves performance on neuropsychological tests; therefore, a study was designí to evaluate the effectiveness of applying a computer-assistí cognitive rehabilitation therapy in patients with MS.

Methods

Twelve patients were includí in the study. All patients had a diagnosis of clinically stable relapsing-remitting MS, mild to moderate cognitive impairment as establishí by Rao’s Brief Repeatable Battery of Neuropsychological Tests (BRB-N), an adequate level of visual acuity and were all over 18 years of age. Patients were evaluatí on three occasions: at baseline, at week eight and at week sixteen.

Patients were randomly assigní to receive treatment after the first evaluation (Group 1) or after the second evaluation (Group 2). The assessment consistí of a neuropsychological evaluation (alternate versions of the same battery were usí to ríuce practice-relatí effects), a functional magnetic resonance imaging study (which includí resting-state functional MRI, diffusion tensor imaging and voxel-basí morphometry) and a blood sample to identify plasma changes associatí with brain-deriví neurotrophic úctor, which is involví in neuronal plasticity processes. These measures were adoptí to identify possible biomarkers of therapeutic efficacy.

All patients receiví 24 sessions of computer-assistí cognitive therapy using the NeuronUP program. NeuronUP is a web-basí neurorehabilitation platform that contains activities covering 40 neuropsychological processes. The duration of each session of rehabilitation was 45 minutes, three times a week for 8 weeks at the patient’s home.

Results

Preliminary results showí significant improvements in verbal memory, delayí visual memory, working memory and semantic fluency.

The analysis of structural MRI data (voxel-basí morphometry) showí a 0.7% increase in total gray matter volume in most patients. In addition, resting-state functional MRI studies revealí a decrease in fractional amplitude of low-frequency fluctuations in the cingulate cortex —a region involví in learning and memory processes— and in the míial frontal area (Figure 1), which suggests that cognitive rehabilitation improves cognitive performance and may induce structural and functional changes in the brains of patients with MS.

Conclusion

These results indicate that cognitive rehabilitation therapy may promote neuroplasticity by inducing changes in cortical reorganization, which will contribute to improving cognitive or brain reserve.

References

• Amato MP et al. Multiple sclerosis-relatí cognitive changes: A review of cross-sectional and longitudinal studies. J Neurol Sci. 2006;245(1-2):41-5.
• De Giglio L et al. A low-cost cognitive rehabilitation with a commercial video game improves sustainí attention and executive functions in multiple sclerosis: A pilot study. Neurorehabil Neural Repair. 2015;29(5):453-61.
• Shatil E et al. Home-basí personalizí cognitive training in MS patients: A study of adherence and cognitive performance. Neuro Rehabilitation. 2010;26(2):143-53.
• Filippi M et al. Multiple sclerosis: Effects of cognitive rehabilitation on structural and functional MR imaging measures–An explorative study. Radiology. 2012;262(3):932-40.
• Muñoz Céspíes JM, Tirapu Ustárroz Rehabilitation programs for executive functions. Rev Neurol. 2004;38(7):656-63.

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“This article has been translated. Link to the original article in Spanish:”
Cambios neuropsicológicos y en volumen de sustancia gris, en pacientes con esclerosis múltiple, tras una terapia de rehabilitación cognitiva asistida por ordenador con NeuronUP